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Carcinomas of the base of the tongue, particularly those related to HPV infection, have a tendency to metastasize early to cervical lymph nodes. In this laryngoscopic video, a small exophytic tumor with central ulceration can be seen at the base of the tongue. The patient had experienced recurrent episodes of hematemesis over the three months prior to admission, accompanied by a reduction in hematocrit. Both gastroscopy and colonoscopy were performed but revealed no relevant pathology. A CT scan of the neck showed suspicious lymph nodes. However, the small primary tumor located on the left side of the base of the tongue was not identified at that time. HPV-related carcinomas of the tonsils or the base of the tongue often metastasize early to cervical lymph nodes and can sometimes initially present as CUP syndrome (Cancer of Unknown Primary), where the metastatic lymph node is detected before the primary tumor is located. Keywords: hematemesis, CUP syndrome, tongue carcinoma, HPV Literature: Faisal M, Le NS, Grasl S, Janik S, Simmel H, Schratter-Sehn AU, Hamzavi JS, Franz P, Erovic BM. Carcinoma of Unknown Primary (CUP) versus CUP Turned to Primary Carcinoma of the Head and Neck-An Analysis of Diagnostic Methods and the Impact of Primary Tumor on Clinical Outcome. Diagnostics (Basel). 2022 Apr 3;12(4):894. doi: 10.3390/diagnostics12040894. PMID: 35453942; PMCID: PMC9032826. Chan SP, McLarty J, Knecht E, Lee SC. Transoral Laser Resection of the Tongue Base in the Workup of Unknown Primary Head and Neck Squamous Cell Carcinoma. Cureus. 2023 Jun 28;15(6):e41103. doi: 10.7759/cureus.41103. PMID: 37519526; PMCID: PMC10382210. Video: GeorgiosPsychogios 2025 Voice: Generated with ElevenLabs